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U.S. Department of Health and Human Services

Food

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NCIMS HACCP Hazard Analysis Worksheet

Return to Dairy Grade A Voluntary HACCP

 

To aid in reading a printed copy it is recommended that it be printed in "landscape" mode.

SUBJECT

Hazard Analysis Worksheet

ISSUE DATEPRODUCT
PLANT NAMESUPERSEDESPAGE
ADDRESS
(1)
Ingredient/Processing Step
(2)
Identify potential food safety hazards introduced, controlled or enhanced1 at this step.
(3)
Are any potential
food-safety
hazards reasonably likely to occur?
(4)
Justify your decision for column 3
(5)
What control measure(s) can be applied to prevent, reduce, or eliminate the food safety hazards?
(6)
Is this step a critical
Control point?
(Yes/No)
 

Biological

Physical

Chemical

unfilled checkbox YES unfilled checkbox NO

unfilled checkbox YES unfilled checkbox NO

unfilled checkbox YES unfilled checkbox NO

  

unfilled checkbox YES

unfilled checkbox NO

 

Biological

Physical

Chemical

unfilled checkbox YES unfilled checkbox NO

unfilled checkbox YES unfilled checkbox NO

unfilled checkbox YES unfilled checkbox NO

  

unfilled checkbox YES

unfilled checkbox NO

Instructions and Example

Raw Milk Receiving

2BiologicalVegetative PathogensYesLikely to occur based on historical dataPasteurization5No
3PhysicalNone(Leave Blank)(Leave Blank)(Leave Blank)
4ChemicalAnimal drug residuesNoAppendix N Testing in PP #5 Protection from Adulteration(Leave Blank)

Approved By:_____________________________________________________ Date:_____________________________
(Signature)


1 Do not carry the hazard through subsequent steps.

2 If a firm identifies a potential hazard in column 2 and yes is noted in column 3, justification is required in column 4 (This justification normally includes the scientific, regulatory, or historical reasons for the decision) and a control measure is required in column 5.

3If a firm does not identify a potential hazard in column 2, then columns 3, 4 and 5 will be blank.

4 If a firm identifies a potential hazard in column 2 and No is noted in column 3, justification is required in column 4. This justification normally includes Prerequisite Programs or procedures that manage the hazard to ensure that control at this step is not necessary. Column 5 will be left blank.

5Column 6 will be answered yes only if the step in column 1 is a critical control point. The control measure is applied at that step.